Cavernous sinus and ophthalmic vein thrombosis in a child: a case report

Cavernous sinus thrombosis is a rare but potentially life-threatening condition, especially in children. Given high mortality of this condition, rapid diagnosis and early treatment are important and can reduce the risk of a poor outcome or death. Clinical presentation is described mainly in adults. The main signs include fever (sometimes with spikes typical for septic thrombophlebitis), tachycardia or hypotension. Ocular symptoms are almost universal and include periorbital edema (initially unilateral, but usually bilateral), eyelid hyperemia, conjunctival chemosis, upper eyelid ptosis, exophthalmos (caused by impaired venous outflow from the orbit), limited or painful eye movements, and less commonly, optic disc edema, retinal hemorrhages, and decreased visual acuity. Most publications on this topic include an analysis of clinical cases; there is very little pooled data on anticoagulant therapy in the publications. As the condition is rare, treatment is based on expert judgment. In general, therapy includes two main strategies—antimicrobial and antithrombotic. Published data on the treatment of children is limited.

The article presents a clinical case of cavernous sinus and orbital vein thrombosis associated with sphenoiditis in a child. The patient had complaints several months before the onset of clear clinical manifestations. He had left upper eyelid edema, severe headaches accompanied by pain in the left eye, and increased body temperature.

Otolaryngologists carried out a surgery for urgent indications the day after the diagnosis. A sphenoidotomy was performed using video endoscopic equipment to debride the left sphenoid sinus. On the day of surgery, sodium heparin was administered as anticoagulant therapy followed by sodium enoxaparin and then long-term rivaroxaban. The case outcome was a complete recovery.

The presented clinical case demonstrates challenging timely diagnosis of cavernous sinus thrombosis in children. It highlights the importance of a detailed medical history and a comprehensive ophthalmological examination for diagnosis. The clinical case features include long-lasting manifestations with many nonspecific complaints from the patient, prolonged diagnosis from the first symptoms, and the onset of symptoms during the COVID-19 pandemic.